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Objectives— To identify the characteristics, management and hospital outcomes of acute coronary syndrome (ACS) patients in the Gulf region of the Middle East.Methods and results— Overall, 8176 consecutive patients with the final diagnosis of ACS were recruited in 6 months, from 64 hospitals in 6 countries.The mean age of patients was 56 years. At presentation, 40% of patients had diabetes and 38% were current smokers. Of 2268 patients eligible for reperfusion, 183 (8%) underwent primary percutaneous coronary intervention, 1856 (82%) received thrombolytic therapy and 219 patients (10%) did not receive any reperfusion.The median door-to-needle time was 45 minutes.The majority of patients received aspirin (96%), beta-blockers (77%), angiotensin-converting enzyme inhibitors (77%) and statins (83%) at discharge. Less than 1 in 5 patients received coronary angiography (19%). Low-risk patients were more likely to undergo coronary angiography than high-risk patients (odds ratio 1.35, 95% confidence interval 1.15 to 1.58, P < 0.001). Patients with recurrent ischaemia were 4 times more likely to undergo coronary angiography than those without;and patients who lived in UAE and Bahrain were about 3-4 times more likely to undergo this procedure than those who lived in other participating countries (P < 0.001 for both).The overall hospital mortality was 3.6%.Conclusions— Patients with ACS in the Arab Middle East are younger than in developed countries and have higher rates of diabetes and smoking. There is good adherence to evidence-based medications; however, improvement in door-to-needle time and utilisation of interventional procedures is needed.

Objectives— First, to compare the in-hospital mortality after acute myocardial infarction (AMI) among diabetic versus non-diabetic patients. Secondly, to evaluate if this association remains the same across gender and ethnic groups.Methods and results— We used a 1:2 individually matched retrospective case-control study. All patients admitted to Mubarak Al-Kabeer hospital in Kuwait, with a confirmed diagnosis of AMI during August 1997 and July 2002 made up the study population. All 149 patients who died during this period made up the cases.Two control subjects to match each case were randomly chosen from survivors, after hospitalization with AMI. Cases and controls were individually matched by age, sex and ethnicity. History of diabetes mellitus (DM) was found to be significantly associated with in-hospital mortality after AMI (odds ratio: 1.9, 95% CI: 1.2-3.0). None of the other cardiovascular related histories were associated with mortality. Further analyses on the type of diabetes showed that the NIDDM (non-insulin dependent diabetes mellitus) risk of mortality was significantly raised after AMI. Also among women (odds ratio: 2.7, 95% CI: 1.2-5.9), and non-Kuwaiti population (odds ratio: 3.4, 95% CI: 1.1-9.9) the risk was significantly elevated.Conclusions— Risk of in-hospital mortality after AMI is almost doubled among diabetic patients. This association was found to be significantly higher among NIDDM, women and non-Kuwaiti population.

Objectives— We studied the use of thrombolytic treatment at a major hospital in Kuwait.There were three aims to our study. First, to document the rates of use and shortfall of thrombolytic therapy. Secondly, to identify the reasons for the shortfall. Thirdly, to study the influence of age and gender on the shortfall.Methods and results— We retrospectively examined the use of thrombolytic treatment in 983 consecutive patients with the diagnosis of acute myocardial infarction (AMI) during a three-year period, from June 1994 to May 1997.The term “shortfall” refers to the number of patients who were eligible for thrombolytic treatment but did not receive it. Patients were relatively young (59% were < 55 years old). There was a high prevalence of diabetes (39%). We identified 669 patients who were eligible to receive thrombolytic therapy (68% of the total AMI population). Of the eligible population, 625 patients (93.4%) received thrombolytic therapy while 44 patients did not (a shortfall of 6.6% among the eligible population). The reasons for the shortfall were: unknown reasons, retinopathy, and others.The shortfall was higher in women than in men (13% vs. 6%, respectively; p=0.02). The shortfall was higher in older patients than in younger patients (18% vs. 5%, respectively; p=0.0002).Conclusions— Our thrombolysis rate is one of the highest, and the shortfall is one of the lowest reported rates in the literature. Many eligible women and older patients are not receiving thrombolytic therapy. Changes to thrombolytic therapy use should be implemented to avoid unnecessary shortfall and potential gender and age bias.